Nalbuphine Is Better Than Naloxone for Treatment of Side Effects After Epidural Morphine

Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries

“…To date, the most effective treatments for opioid-induced pruritus have included pharmacologic agents that antagonize the μ-opioid receptor, which pose disadvantages in that they can reverse analgesia. 107,132 Clinically, μ-opioid receptor antagonists have also been shown to be effective for the management of parenteral opioid-induced pruritus. 129 For patients on parenteral opioid therapy, such as patients with sickle cell disease, the coadministration of the opioid analgesic and its antagonist helps to mitigate pruritus, 42 particularly when small doses are infused (e.g., naloxone 0.25 to 2 μg • kg -1 • h -1 intravenous push).…”

“…Alternatively, mixed opioid receptor agonists, such as nalbuphine (1 to 5 mg IV) 136 and butorphanol (0.2 to 2 mg IV) 137 are also clinically effective therapies for neuraxial opioid-induced pruritus. 19,107,138 They are frequently used due to their improved ability to manage pruritus without reducing analgesia compared to selective μ-opioid receptor antagonists. 107 Nalbuphine is a mixed antagonist of the μ-opioid receptor and agonist of the κ-opioid receptor, and because of its partial antagonism of the μ-opioid receptor, reversal of analgesia remains a concern.…”

“…19,107,138 They are frequently used due to their improved ability to manage pruritus without reducing analgesia compared to selective μ-opioid receptor antagonists. 107 Nalbuphine is a mixed antagonist of the μ-opioid receptor and agonist of the κ-opioid receptor, and because of its partial antagonism of the μ-opioid receptor, reversal of analgesia remains a concern. 109 Another potential limitation of nalbuphine is its sedating side effect, 19,133 although this is only observed when a high dose (10 mg/70 kg) is used, 139 which is beyond the range used to manage pruritus clinically.…”